Prevalence of cryoglobulinemia and autoimmune markers in liver transplant patients.
OBJECTIVE
To examine the prevalence of cryoglobulinemia and autoimmune markers in stable liver transplant recipients and to determine risk factors and clinical impact.


METHODS
Ninety-two liver transplant recipients were tested for cryoglobulinemia, hepatitis B and C, complement C3, complement C4, CH50, antinuclear antibodies, anticytoplasmic neutrophil antibodies, anticardiolipid antibodies, rheumatoid factors, and lymphocyte subpopulations. Liver, renal, and hematology tests were done. Immunosuppressive regimens were based on calcineurin inhibitors in 94.6% of the patients.


RESULTS
Cryoglobulinemia was present in 18 patients (19.5%) with characteristics of type II in 27.7%, type III in 61.3%, and indeterminate in 11%. Cryoglobulinemia was present in 55.5% of patients with positive hepatitis C virus serology compared with 35.86% of patients with negative hepatitis C virus serology (P = .06). Among those with hepatitis C virus markers, cryoglobulinemia was present in 30%. Anticytoplasmic neutrophil antibodies were positive in 23% of the patients with cryoglobulinemia, but in only 5.4% of the patients without cryoglobulinemia (P = .006). Albuminemia was significantly lower in patients with cryoglobulinemia (38 -/+ 4.2 g/L) than it was in patients without cryoglobulinemia (40.2 -/+ 3.4; P = .05). Cryoglobulinemia was symptomatic in 4 patients (22.2% of all patients). Independent factors associated with cryoglobulinemia were presence of anticytoplasmic neutrophil antibodies, more than 4 HLA incompatibilities, alanine aminotransferase level of 0.68 microkat/L or more, and an albuminemia level greater than 38 g/L.


CONCLUSIONS
Cryoglobulinemia is frequent after liver transplant and is symptomatic in approximately 20% of all patients.
Garrouste
Cyril
C
Nephrology, Dialysis, and Multiorgan Transplant Unit, University Hospital, CHU Rangueil, Toulouse, France.
Kamar
Nassim
N
Boulestin
Anne
A
Esposito
Laure
L
Lavayssiere
Laurence
L
Durand
Dominique
D
Blancher
Antoine
A
Rostaing
Lionel
L
D000328:Adult; D000368:Aged; D015551:Autoimmunity / Q000276:immunology*; D003404:Creatinine / Q000378:metabolism; D003449:Cryoglobulinemia / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology*; D011795:Surveys and Questionnaires; D055815:Young Adult
D003404:Creatinine